Bipolar disorder

Bipolar disorder — sometimes called
manic-depressive disorder — causes mood swings that range from of the
lows of depression to the highs of mania. When you become depressed, you
may feel sad or hopeless and lose interest or pleasure in most
activities. When your mood shifts in the other direction, you may feel
euphoric and full of energy. Mood shifts may only occur only a few times
a year, or as often as several times a day. In some cases, bipolar
disorder causes symptoms of depression and mania at the same time.

Although bipolar disorder is a disruptive, long-term condition, you can
keep your moods in check by following a treatment plan. In most cases,
bipolar disorder can be controlled with medications and psychological
counseling (psychotherapy).

Symptoms

Bipolar disorder is divided into several subtypes. Each has a different pattern of symptoms. Types of bipolar disorder include:

* Bipolar I disorder. Mood swings with bipolar I cause significant
difficulty in your job, school or relationships. Manic episodes can be
severe and dangerous.
* Bipolar II disorder. Bipolar II is less severe than bipolar I. You
may have an elevated mood, irritability and some changes in your
functioning, but generally you can carry on with your normal daily
routine. Instead of full-blown mania, you have hypomania — a less severe
form of mania. In bipolar II, periods of depression typically last
longer than periods of hypomania.
* Cyclothymia. Cyclothymia is a mild form of bipolar disorder. With
cyclothymia, hypomania and depression can be disruptive, but the highs
and lows are not as severe as they are with other types of bipolar
disorder.

Bipolar disorder symptoms reflect a range of moods.

The exact symptoms of bipolar disorder vary from person to person. For
some people, depression causes the most problems; for other people manic
symptoms are the main concern. Symptoms of depression and symptoms of
mania or hypomania may also occur together. This is known as a mixed
episode.

Manic phase of bipolar disorder
Signs and symptoms of the manic or hypomanic phase of bipolar disorder can include:

* Euphoria
* Extreme optimism
* Inflated self-esteem
* Poor judgment
* Rapid speech
* Racing thoughts
* Aggressive behavior
* Agitation or irritation
* Increased physical activity
* Risky behavior
* Spending sprees or unwise financial choices
* Increased drive to perform or achieve goals
* Increased sex drive
* Decreased need for sleep
* Inability to concentrate
* Careless or dangerous use of drugs or alcohol
* Frequent absences from work or school
* Delusions or a break from reality (psychosis)
* Poor performance at work or school

Depressive phase of bipolar disorder
Signs and symptoms of the depressive phase of bipolar disorder can include:

* Sadness
* Hopelessness
* Suicidal thoughts or behavior
* Anxiety
* Guilt
* Sleep problems
* Low appetite or increased appetite
* Fatigue
* Loss of interest in daily activities
* Problems concentrating
* Irritability
* Chronic pain without a known cause
* Frequent absences from work or school
* Poor performance at work or school

Other signs and symptoms bipolar disorder
Signs and symptoms of bipolar disorder can also include:

* Seasonal changes in mood. As with seasonal affective disorder
(SAD), some people with bipolar disorder have moods that change with the
seasons. Some people become manic or hypomanic in the spring or summer
and then become depressed in the fall or winter. For other people, this
cycle is reversed — they become depressed in the spring or summer and
manic or hypomanic in the fall or winter.
* Rapid cycling bipolar disorder. Some people with bipolar disorder
have rapid mood shifts. This is defined as having four or more mood
swings within a single year. However, in some people moods shifts occur
much more quickly, sometimes within just hours.
* Psychosis. Severe episodes of either mania or depression may
result in psychosis, a detachment from reality. Symptoms of psychosis
may include false but strongly held beliefs (delusions) and hearing or
seeing things that aren't there (hallucinations). In some people, sudden
psychosis (a psychotic break) is the first sign of bipolar disorder.

Symptoms in children and adolescents
Instead of clear-cut depression and mania or hypomania, the most
prominent signs of bipolar disorder in children and adolescents can
include explosive temper, rapid mood shifts, reckless behavior and
aggression. In some cases, these shifts occur within hours or less — for
example, a child may have intense periods of giddiness and silliness,
long bouts of crying and outbursts of explosive anger all in one day.
Changing sleep patterns are also a common indicator of childhood bipolar
disorder.

When to see a doctor
If you have any symptoms of depression or mania, see your doctor or
mental health provider. Bipolar disorder doesn't get better on its own.
Getting treatment from a mental health provider with experience in
bipolar disorder can help you get your symptoms under control.

Many people with bipolar disorder don't get the treatment they need.
Despite the mood extremes, people with bipolar disorder often don't
recognize how much their emotional instability disrupts their lives and
the lives of their loved ones. And if you're like some people with
bipolar disorder, you may enjoy the feelings of euphoria and cycles of
being more productive. However, this euphoria is always followed by an
emotional crash that can leave you depressed, worn out — and perhaps in
financial, legal or relationship trouble.

If you're reluctant to seek treatment, confide in a friend or loved one,
a health care professional, a faith leader or someone else you trust.
They can help you take the first steps to successful treatment.

If you have suicidal thoughts
Suicidal thoughts and behavior are common among people with bipolar
disorder. If you or someone you know is having suicidal thoughts, get
help right away. Here are some steps you can take:

* Contact a family member or friend.
* Seek help from your doctor, a mental health provider or other health care professional.
* Call a suicide hot line number — in the United States, you can
reach the toll-free, 24-hour hot line of the National Suicide Prevention
Lifeline at 800-273-8255 to talk to a trained counselor.
* Contact a minister, spiritual leader or someone in your faith community.

When to get emergency help
If you think you may hurt yourself or attempt suicide, call 911 or your
local emergency number immediately. If you have a loved one who has
harmed himself or herself, or is seriously considering doing so, make
sure someone stays with that person. Take him or her to the hospital or
call for emergency help.

Causes

Several factors seem to be involved in causing and triggering bipolar episodes:

* Biological differences. People with bipolar disorder appear to
have physical changes in their brains. The significance of these changes
is still uncertain but may eventually help pinpoint causes.
* Neurotransmitters. An imbalance in naturally occurring brain
chemicals called neurotransmitters seems to play a significant role in
bipolar disorder and other mood disorders.
* Hormones. Imbalanced hormones may be involved in causing or triggering bipolar disorder.
* Inherited traits. Bipolar disorder is more common in people who
have a blood relative (such as a sibling or parent) with the condition.
Researchers are trying to find genes that may be involved in causing
bipolar disorder.
* Environment. Stress, abuse, significant loss or other traumatic experiences may play a role in bipolar disorder.

Risk factors

Factors that may increase the risk of developing bipolar disorder include:

* Having blood relatives such as a parent or sibling with bipolar disorder
* Periods of high stress
* Drug or alcohol abuse
* Major life changes, such as the death of a loved one
* Being between the ages of 15 and 30

Conditions that commonly occur with bipolar disorder
If you have bipolar disorder, you may also have another health condition
that's diagnosed before or after your diagnosis of bipolar disorder.
Such conditions need to be diagnosed and treated because they may worsen
existing bipolar disorder. They include:

* Anxiety disorders. Examples include post-traumatic stress disorder (PTSD), social phobia and generalized anxiety disorder.
* Attention-deficit/hyperactivity disorder (ADHD). ADHD has symptoms
that overlap with bipolar disorder. For this reason, bipolar disorder
can be difficult to differentiate from ADHD. Sometimes one is mistaken
for the other. In some cases, a person may be diagnosed with both
conditions.
* Addiction or substance abuse. Many people with bipolar disorder
also have alcohol or drug problems. Street drugs or alcohol may seem to
ease symptoms, but they can actually trigger, prolong or worsen
depression or mania.
* Physical health problems. People diagnosed with bipolar disorder
are more likely to have certain other health problems, including heart
disease, thyroid problems and obesity.

Complications

Left untreated, bipolar disorder can result in serious problems that affect every area of your life. These can include:

* Problems related to substance and alcohol abuse
* Legal problems
* Financial problems
* Relationship troubles
* Isolation and loneliness
* Poor work or school performance
* Frequent absences from work or school
* Suicide

Preparing for your appointment

You're likely to start by first seeing your family doctor or a general
practitioner. However, in some cases when you call to set up an
appointment, you may be referred immediately to a psychiatrist — a
medical doctor who specializes in diagnosing and treating mental health
conditions.

Because appointments can be brief, and because there's often a lot of
ground to cover, it's a good idea to be well prepared for your
appointment. Here's some information to help you get ready for your
appointment, and what to expect from your doctor.

What you can do

* Write down any symptoms you've had, including any that may seem
unrelated to the reason for which you scheduled the appointment.
* Write down key personal information, including any major stresses or recent life changes.
* Make a list of all medications, as well as any vitamins or supplements that you're taking.
* Take a family member or friend along, if possible. Sometimes it
can be difficult to soak up all the information provided to you during
an appointment. Someone who accompanies you may remember something that
you missed or forgot.
* Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions
ahead of time will help you make the most of your time together. List
your questions from most important to least important in case time runs
out. For problems related to bipolar disorder, some basic questions to
ask your doctor include:

* Is bipolar disorder likely causing my symptoms or condition?
* Other than the most likely cause, what are other possible causes for my symptoms or condition?
* What kinds of tests will I need?
* What treatment is likely to work best for me?
* What are the alternatives to the primary approach that you're suggesting?
* I have these other health conditions. How can I best manage them together?
* Are there any restrictions that I need to follow?
* Should I see a psychiatrist or other mental health provider? What
will that cost, and will my insurance cover seeing a specialist?
* Is there a generic alternative to the medicine you're prescribing me?
* Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend visiting?

In addition to the questions that you've prepared to ask your doctor,
don't hesitate to ask questions during your appointment at any time that
you don't understand something.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to
answer them may reserve time to go over any points you want to spend
more time on. Your doctor may ask:

* When did you or your loved ones first begin noticing your symptoms of depression, mania or hypomania?
* How frequently do your moods change?
* Do you ever have suicidal thoughts when you're feeling down?
* How severe are your symptoms? Do they interfere with your daily life or relationships?
* Do you have any blood relatives with bipolar disorder or another mood disorder?
* What other mental or physical health conditions do you have?
* Do you drink alcohol or use street drugs?
* How much do you sleep at night? Does it change over time?
* Do you go through periods when you take risks you wouldn't
normally take, such as unsafe sex or unwise, spontaneous financial
decisions?
* What, if anything, seems to improve your symptoms?
* What, if anything, appears to worsen your symptoms?

Tests and diagnosis

When doctors suspect someone has bipolar disorder, they typically do a
number of tests and exams. These can help rule out other problems,
pinpoint a diagnosis and also check for any related complications. These
can include:

* Physical exam. This may involve measuring your height and weight;
checking your vital signs, such as heart rate, blood pressure and
temperature; listening to your heart and lungs; and examining your
abdomen.
* Lab tests. These may include blood and urine tests. These tests
can help identify any physical problems that could be causing your
symptoms.
* Psychological evaluation. A doctor or mental health provider will
talk to you about your thoughts, feelings and behavior patterns. You may
also fill out a psychological self-assessment or questionnaire. With
your permission, family members or close friends may be asked to provide
information about your symptoms and possible episodes of mania or
depression.
* Mood charting. To identify exactly what's going on, your doctor
may have you keep a daily record of your moods, sleep patterns or other
factors that could help with diagnosis and finding the right treatment.

Diagnostic criteria for bipolar disorder
To be diagnosed with bipolar disorder, you must meet the criteria
spelled out in the Diagnostic and Statistical Manual of Mental Disorders
(DSM). This manual is published by the American Psychiatric Association
and is used by mental health providers to diagnose mental conditions
and by insurance companies to reimburse for treatment. Diagnostic
criteria for bipolar disorder are based on the specific type of bipolar
disorder.

* Bipolar I disorder: You've had at least one manic or one mixed
episode. You may or may not have had a major depressive episode. Because
bipolar I varies from person to person, there are more specific
subcategories of diagnosis based on your particular signs and symptoms.
* Bipolar II disorder: You've had at least one major depressive
episode and at least one hypomanic episode (but not a fully manic or
mixed episode). With bipolar II, symptoms cause distress or difficulty
in some area of your life — such as relationships or work. Bipolar II
disorder also has subcategories based on your particular signs and
symptoms.
* Cyclothymic disorder: You've had numerous hypomanic episodes and
periods of depression — but you've never had a full manic episode, a
major depressive episode or a mixed episode. For a diagnosis of
cyclothymic disorder, symptoms last two years or more (one year in
children and adolescents). During that time, symptoms never go away for
more than two months. Symptoms cause significant distress or difficulty
in some area of your life — such as in relationships or at work.

The DSM has very specific criteria for manic, hypomanic, major depressive and mixed episodes:

Criteria for a manic episode
A manic episode is a distinct period of abnormally and persistently
elevated, expansive, or irritable mood that lasts at least one week (or
less than a week if hospitalization is necessary). During the period of
disturbed mood, three or more of the following symptoms must be present
(four if the mood is only irritable):

* Inflated self-esteem or grandiosity
* Decreased need for sleep (for example, you feel rested after only three hours of sleep)
* Unusual talkativeness
* Racing thoughts
* Distractibility
* Increased goal-directed activity (either socially, at work or school, or sexually)
* Engagement in pleasurable activities that have a high potential
for painful consequences — for example, unrestrained buying sprees,
sexual indiscretions or foolish business investments

To be considered a manic episode:

* The mood disturbance must be severe enough to cause noticeable
difficulty at work, at school or in usual social activities or
relationships; to require hospitalization to prevent harm to yourself or
others; or to trigger a break from reality (psychosis).
* Symptoms do not meet the criteria for a mixed episode (see criteria for mixed episode below).
* Symptoms are not due to the direct effects of something else such
as alcohol or drug use, taking a medication, or a having a medical
condition such as hyperthyroidism.

Criteria for a hypomanic episode
A hypomanic episode is a distinct period of elevated, expansive, or
irritable mood that lasts at least four days, and is different from the
usual nondepressed mood. During the period of disturbed mood, three or
more of the following symptoms must be present (four if the mood is only
irritable):

* Inflated self-esteem or grandiosity
* Decreased need for sleep (for example, you feel rested after only three hours of sleep)
* Unusual talkativeness
* Racing thoughts
* Distractibility
* Increased goal-directed activity (either socially, at work or school, or sexually)
* Engagement in pleasurable activities that have a high potential
for painful consequences — for example, unrestrained buying sprees,
sexual indiscretions or foolish business investments

To be considered a hypomanic episode:

* The mood disturbance must be severe enough to cause a noticeable and uncharacteristic change in functioning.
* The episode isn't severe enough to cause significant difficulty at
work, at school or in usual social activities or relationships; to
require hospitalization; or to trigger a break from reality (psychosis).
* Symptoms do not meet the criteria for a mixed episode (see criteria for mixed episode below).
* Symptoms are not due to the direct effects of something else such
as alcohol or drug use, taking a medication, or a having a medical
condition such as hyperthyroidism.

Criteria for a major depressive episode
To be diagnosed with a major depressive episode, you must have five (or
more) of the following symptoms over a two-week period. At least one of
the symptoms is either depressed mood or loss of interest or pleasure.
Symptoms can be based on your own feelings or on the observations of
someone else. They include:

* Depressed mood most of the day, nearly every day, such as feeling
sad, empty or tearful (in children and adolescents, depressed mood can
appear as constant irritability)
* Diminished interest or feeling no pleasure in all — or almost all — activities most of the day, nearly every day
* Significant weight loss when not dieting, weight gain, or decrease
or increase in appetite nearly every day (in children, failure to gain
weight as expected can be a sign of depression)
* Insomnia or increased desire to sleep nearly every day
* Either restlessness or slowed behavior that can be observed by others
* Fatigue or loss of energy nearly every day
* Feelings of worthlessness or excessive or inappropriate guilt nearly every day
* Diminished ability to think or concentrate, or indecisiveness, nearly every day
* Recurrent thoughts of death or suicide, or a suicide attempt

To be considered a major depressive episode:

* Symptoms don't meet the criteria for a mixed episode (see criteria for mixed episode below)
* Symptoms must be severe enough to cause noticeable difficulty in
day-to-day activities, such as work, school, social activities or
relationships with others
* Symptoms are not due to the direct effects of something else, such
as drug abuse, taking a medication or a having a medical condition such
as hyperthyroidism
* Symptoms are not caused by grieving, such as after the loss of a loved one

Criteria for mixed episode

* The criteria are met both for a manic episode and for a major
depressive episode nearly every day during at least a one-week period
* The mood disturbance must be severe enough to cause noticeable
difficulty at work, at school, or in usual social activities or
relationships; to require hospitalization to prevent harm to self or
others; or to cause a break from reality (psychosis)
* Symptoms are not due to the direct effects of something else, such
as drug abuse, taking a medication or a having a medical condition such
as hyperthyroidism

Diagnosis in children
The same official criteria used to diagnose bipolar disorder in adults
are used to diagnose children and adolescents. However, bipolar symptoms
in children and adolescents often have different patterns than they do
in adults, and may not fit neatly into the categories used for
diagnosis. While adults generally tend to have distinct periods of mania
and depression, children and adolescents may have erratic, rapid
changes in mood, behavior and energy levels.

It's often hard to tell whether these are normal ups and downs, the
results of stress or trauma, or signs of a mental health problem other
than bipolar disorder. To make it even more difficult, children who have
bipolar disorder are frequently also diagnosed with other mental health
conditions such as attention-deficit/hyperactivity disorder (ADHD) or
behavior problems such as oppositional defiant disorder (ODD).

Although bipolar disorder can occur in young children, diagnosis in
children preschool age or younger is especially difficult. The current
criteria used for diagnosis have not been proved in young children, and a
wide range of issues other than bipolar disorder can cause mood and
behavior problems at this age.

Treatments and drugs

Bipolar disorder requires lifelong treatment, even during periods when
you feel better. Treatment is usually guided by a psychiatrist skilled
in treating the condition. You may have a treatment team that also
includes psychologists, social workers and psychiatric nurses. The
primary treatments for bipolar disorder include medications; individual,
group or family psychological counseling (psychotherapy); or education
and support groups.

* Hospitalization may be needed if you are behaving dangerously, you
feel suicidal or you become detached from reality (psychotic).
* Initial treatment generally involves taking medications to balance
your moods right away. Once your symptoms are under control, you'll
work with your doctor to find the best long-term treatment.
* Continued treatment (maintenance treatment) is used to manage
bipolar disorder on a long-term basis. People who skip maintenance
treatment are at high risk of a relapse of symptoms or having minor mood
changes turn into full-blown mania or depression.
* Substance abuse treatment may be necessary if you have problems
with alcohol or drugs. Otherwise, it can be very difficult to manage
bipolar disorder.

Medications
A number of medications are used to treat bipolar disorder. If one
doesn't work well for you, there are a number of others to try. Your
doctor may suggest combining medications for maximum effect. Medications
for bipolar disorder include those that prevent the extreme highs and
lows that can occur with bipolar disorder (mood stabilizers) and
medications that help with depression or anxiety.

Medications for bipolar disorder include:

* Lithium. Lithium (Lithobid, others) is effective at stabilizing
mood and preventing the extreme highs and lows of certain categories of
bipolar disorder and has been used for many years. Periodic blood tests
are required, since lithium can cause thyroid and kidney problems.
Common side effects include tremor, weight gain and digestive issues.
* Anticonvulsants. These mood stabilizing medications include
valproic acid (Depakene), divalproex (Depakote) and lamotrigine
(Lamictal). The medication asenapine (Saphris) may be helpful in
treating mixed episodes. Depending on the medication you take, side
effects can vary. Common side effects include weight gain, tremor and
drowsiness. Rarely, certain anticonvulsants cause more serious problems,
such as skin rashes, blood disorders or liver problems.
* Antidepressants. Depending on your symptoms, your doctor may or
may not recommend you take an antidepressant. In some people with
bipolar disorder, antidepressants can trigger manic episodes, but may be
OK if taken along with a mood stabilizer. The most common
antidepressant side effects include reduced sexual desire and problems
reaching orgasm. Older antidepressants, which include tricyclics and MAO
inhibitors, can cause a number of potentially dangerous side effects
and require careful monitoring.
* Antipsychotics. Certain antipsychotic medications, such as
olanzapine (Zyprexa), risperidone (Risperdal) and quetiapine (Seroquel),
may help people who don't gain benefits from anticonvulsants. Side
effects depend on the medication, but can include weight gain,
sleepiness, tremors, dry mouth, blurred vision and sexual side effects.
Weight gain in children is a significant concern. Antipsychotic use may
also affect memory and attention and cause involuntary facial or body
movements.
* Symbyax. This medication combines the antidepressant fluoxetine
and the antipsychotic olanzapine - it works as a depression treatment
and a mood stabilizer. Side effects can include weight gain, drowsiness,
dry mouth, increased appetite and fatigue. This medication may also
cause sexual problems similar to those caused by antidepressants.
* Benzodiazepines. These anti-anxiety medications may help with
anxiety and improve sleep. Examples include clonazepam (Klonopin),
lorazepam (Ativan), diazepam (Valium), chlordiazepoxide (Librium) and
alprazolam (Xanax). Benzodiazepines are generally used for relieving
anxiety only on a short-term basis. Side effects can include drowsiness,
reduced muscle coordination, and problems with balance and memory.

Finding the right medication
Everyone's different, so finding the right medication or medications for
you will likely take some trial and error. This requires patience, as
some medications need eight weeks or longer to take full effect.
Generally only one medication is changed at a time so your doctor can
identify which medications work to relieve your symptoms with the least
bothersome side effects. This can take months or longer, and medications
may need to be adjusted as your symptoms change. Side effects improve
as you find the right medications and doses that work for you, and your
body adjusts to the medications.

Medications and pregnancy
A number of medications for bipolar disorder can cause birth defects.

* Use effective birth control (contraception) to prevent pregnancy.
Discuss birth control options with your doctor, as birth control
medications may lose effectiveness when taken along with certain bipolar
disorder medications.
* If you plan to become pregnant, meet with your doctor to discuss your treatment options.
* Discuss breast-feeding with your doctor, as some bipolar medications can pass through breast milk to your infant.

Psychotherapy
Psychotherapy is another vital part of bipolar disorder treatment. Several types of therapy may be helpful. These include:

* Cognitive behavioral therapy. This is a common form of individual
therapy for bipolar disorder. The focus of cognitive behavioral therapy
is identifying unhealthy, negative beliefs and behaviors and replacing
them with healthy, positive ones. It can help identify what triggers
your bipolar episodes. You also learn effective strategies to manage
stress and to cope with upsetting situations.
* Education. Counseling to help you learn about bipolar disorder
(psychoeducation) can help you and your loved ones understand bipolar
disorder. Knowing what's going on can help you get the best support and
treatment, and help you and your loved ones recognize warning signs of
mood swings.
* Family therapy. Family therapy involves seeing a psychologist or
other mental health provider along with your family members. Family
therapy can help identify and reduce stress within your family. It can
help your family learn how to communicate better, solve problems and
resolve conflicts.
* Group therapy. Group therapy provides a forum to communicate with
and learn from others in a similar situation. It may also help build
better relationship skills.
* Other therapies. Other therapies that have been studied with some
evidence of success include early identification and therapy for
worsening symptoms (prodrome detection) and therapy to identify and
resolve problems with your daily routine and interpersonal relationships
(interpersonal and social rhythm therapy). Ask your doctor if any of
these options may be appropriate for you.

Electroconvulsive therapy (ECT)
Electroconvulsive therapy can be effective for people who have episodes
of severe depression or feel suicidal or people who haven't seen
improvements in their symptoms despite other treatment. With ECT,
electrical currents are passed through your brain. Researchers don't
fully understand how ECT works. But it's thought that the electric shock
causes changes in brain chemistry that leads to improvements in your
mood. ECT may be an option if you have mania or severe depression when
you're pregnant and cannot take your regular medications.

Hospitalization
In some cases, people with bipolar disorder benefit from
hospitalization. Getting psychiatric treatment at a hospital can help
keep you calm and safe and stabilize your mood, whether you're having a
manic episode or a deep depression. Partial hospitalization or day
treatment programs also are options to consider. These programs provide
the support and counseling you need while you get symptoms under
control.

Treatment in children and adolescents
Children and adolescents with bipolar disorder are prescribed the same
types of medications as those used in adults. However, there's very
little research on the safety and effectiveness of bipolar medications
in children, so treatment decisions are based on adult research.
Treatments are generally decided on a case-by-case basis, depending on
exact symptoms, medication side effects and other factors. As with
adults, ECT may be an option for adolescents with severe bipolar I
symptoms or for whom medications don't work.

Most children diagnosed with bipolar disorder require counseling as part
of initial treatment and to keep symptoms from returning. Psychotherapy
— along with working with teachers and school counselors — can help
children develop coping skills, address learning difficulties and
resolve social problems. It can also help strengthen family bonds and
communication. Psychotherapy may also be necessary to resolve substance
abuse problems, common in older children with bipolar disorder.

Lifestyle and home remedies

You'll probably need to make lifestyle changes to stop cycles of
behavior that worsen your bipolar disorder, and to make sure you get the
support you need from people in your life. Here are some steps to take:

* Quit drinking or using illicit drugs. One of the biggest concerns
with bipolar disorder is the negative consequences of risk-taking
behavior and drug or alcohol abuse. Get help if you have trouble
quitting on your own.
* Steer clear of unhealthy relationships. Surround yourself with
people who are a positive influence and won't encourage unhealthy
behavior or attitudes that can worsen your bipolar disorder.
* Get regular exercise. Moderate, regular exercise can help steady
your mood. Working out releases brain chemicals that make you feel good
(endorphins), can help you sleep and has a number of other benefits.
* Get plenty of sleep. Sleeping enough is an important part of
managing your mood. If you have trouble sleeping, talk to your doctor or
mental health provider about what you can do.

Alternative medicine

Some alternative treatments may help, but there isn't much research on
them. Most of the studies that do exist are on major depression, so it
isn't clear how well most of these work for bipolar disorder.

* Omega-3 fatty acids. These oils may help improve brain function
and depression associated with bipolar disorder. Bipolar disorder
appears to be less common in areas of the world where people regularly
eat fish rich in omega-3s. Omega-3s appear to have a number of health
benefits, but more studies are needed to determine just how much they
help with bipolar disorder.
* St. John's wort. This herb may be helpful with depression.
However, it can also interact with antidepressants and other
medications, and has the potential to trigger mania in some people.
* S-adenosyl-L-methionine (SAMe). This amino acid supplement appears
to help brain function related to depression. It isn't clear yet
whether it's helpful in people with bipolar disorder. As with St. John's
wort, SAMe can trigger mania in some people.
* Herbal combinations. Herbal remedies that combine a number of
different herbs, such as those used in traditional Chinese medicine,
haven't been well studied. Some appear to help, but the risks and
benefits still aren't clear.
* Acupuncture. This ancient Chinese practice of inserting tiny
needles into the skin may relieve depression, but more studies are
needed to confirm its benefits. However, it won't hurt for you to try it
— acupuncture is safe and can be done along with other bipolar disorder
treatments.
* Yoga. Yoga may help ease depression and mood swings associated
with bipolar disorder. It also has a number of other health benefits.
* Massage therapy. Massage may also help relieve anxiety and stress, which can worsen bipolar symptoms.

Although some alternative medicine treatments can be a good addition to your regular treatment, take some precautions first:

* Don't stop taking your prescribed medications or skip therapy
sessions. Alternative medicine is not a substitute for regular medical
care when it comes to treating bipolar disorder.
* Be honest with your doctors and mental health providers. Tell them
exactly which complementary treatments you use or would like to try.
* Be aware of potential dangers. Just because it's natural doesn't
mean it's safe. Before using alternative medicine, be sure you know the
risks, including possible interactions with medications.


Coping and support

Coping with bipolar disorder can be challenging. Here are some things that can help:

* Learn about bipolar disorder. Education about your condition can
empower you and motivate you to stick to your treatment plan. Likewise,
help educate your family and friends about what you're going through.
* Join a support group. Support groups for people with bipolar
disorder can help you connect to others facing similar challenges and
share experiences.
* Stay focused on your goals. Recovery from bipolar disorder can
take time. Stay motivated by keeping your recovery goals in mind and
reminding yourself that you can work to repair damaged relationships and
other problems caused by your mood swings.
* Find healthy outlets. Explore healthy ways to channel your energy, such as hobbies, exercise and recreational activities.
* Learn ways to relax and manage stress. Yoga, tai chi, meditation, or other relaxation techniques can be helpful.


Prevention

There's no sure way to prevent bipolar disorder. However, getting
treatment at the earliest sign of a mental health disorder can help
prevent bipolar disorder or other mental health conditions from
worsening.

If you've been diagnosed with bipolar disorder, some strategies can help
prevent minor episodes from becoming full-blown episodes of mania or
depression:

* Pay attention to warning signs. Addressing symptoms early on can
prevent episodes from getting worse. You and your caregivers may have
identified a pattern to your bipolar episodes and what triggers them.
Call your doctor if you feel you're falling into an episode of
depression or mania. Involve family members or friends in watching for
warning signs.
* Avoid drugs and alcohol. Even though you may feel better, using
alcohol or street drugs makes your symptoms more likely to come back.
* Take your medications exactly as directed. Medications can have
unwanted side effects, and you may feel unhappy about having a mental
health condition that requires lifelong treatment. During periods when
you feel better, you may be tempted to stop treatment. This can have
immediate consequences — you may become very depressed, feel suicidal,
or go into a manic or hypomanic episode. If you think you need to make a
change, call your doctor.
* Check first before taking other medications. Call the doctor who's
treating you for bipolar disorder before you take medications
prescribed by another doctor. Sometimes other medications trigger
episodes of bipolar disorder or may interfere with medications you're
already taking to treat bipolar disorder.